Working with the Welsh Government to change policy and practice in the delivery of adult social care

Impact Area: Health and Social Care

Institution: Manchester Metropolitan University Business School

Leading Academic: Professor Carol Atkinson


Domiciliary care is an important service that supports people to continue living in their own homes. As with many countries, Wales’s aging population is likely to generate an increasing demand for this service. However, providers struggle to recruit and retain enough domiciliary care workers to meet increased demand, making it difficult to deliver the quality of service required.

In Wales there are an estimated 19,500 domiciliary care workers delivering around 260,000 hours of care a week to 23,000 people. Many of these are employed on zero-hour contracts, where there are no guaranteed hours of work each week, and this impacts the ability of care workers to provide an effective level of care to care recipients. To compound the problem, inadequate funding levels and commissioning models have led to low hourly rates of pay for care workers.


Manchester Metropolitan University was commissioned by the Welsh Government to investigate potential policy solutions to boost the recruitment and retention of domiciliary care workers. The research was undertaken by Professor Carol Atkinson (Faculty of Business and Law) and researchers from Decent Work and Productivity.

The research found that zero-hour contracts increase anxiety around job security and create strain and dissatisfaction for care workers and recipients. Coupled with low pay, these contracts have created a recruitment and retention crisis, which makes it difficult to adequately train care workers and negatively impacts the reliability, flexibility and continuity of domiciliary care.

The report offered a series of solutions that centred on creating better terms and conditions of employment for domiciliary care workers. Central to these, was the offer of guaranteed-hours contracts and a fair rate of pay. Ensuring a skilled workforce via training and the establishment of clearer career paths, was also important in addressing recruitment and retention difficulties and creating a skilled and stable workforce. Finally, the importance of positioning care work as an attractive career option both in schools and colleges and the media was highlighted.

In January 2016, the report underpinned a Phase 1 consultation on Welsh Government policy and strategy on social care regulation. This formed the basis of later consultations and a change in regulations relating to care worker employment.


The report’s findings had a direct and significant impact on Welsh Government policy and strategy on social care reforms. In 2015, Welsh Government enacted the Social Services and Well-Being (Wales) Act and began to develop associated legislation, importantly here the Regulation and Inspection of Social Care (Wales) Act (2016). Manchester Met’s research underpinned both the Phase 1 consultation and, in June 2017, the Phase 2 Consultation document laid out plans for new proposals directly informed by the research undertaken by Manchester Metropolitan University. The consultation received 108 responses from a wide range of stakeholders. On the consultation, Rebecca Evans, Minister for Social Services and Public Health, wrote in a statement:

‘In September 2015, the Welsh Government commissioned important primary and secondary research from Manchester Metropolitan University on the relationship between the terms and conditions of domiciliary social workers and the quality of the care delivered. This research concluded there was a clear and convincing link.

‘Proposals consulted on included matters relating to zero hours contracts, compliance with the national minimum wage, travel time, call clipping and length of calls, career structure, development and training, occupational status and health and safety.

‘I have asked the Care Council for Wales to consider and use this report in the development of their five-year strategy for domiciliary care in Wales. This work, commissioned by the Welsh Government, will deliver a sector-led plan for improvement in social care…’

When the 2016 Act came into force in April 2018, the Welsh Government introduced new regulations, again directly citing the Manchester Met research, requiring employers to give domiciliary care workers the option of a guaranteed-hours contract after three months of employment and so reducing reliance on zero-hour contracts. This created the opportunity to substantially improve both employment conditions for care workers, and the quality of care they deliver.

The research also underpinned a study commissioned by the Greater Manchester Combined Authority (GMCA) to propose policy solutions to address low pay and productivity in Greater Manchester, with a specific focus on adult social care. This study provided a technical report for GMCA’s Independent Prosperity Review, which forms part of the local Industrial Strategy evidence base submitted to central Government in March 2019. This again creates the opportunity to improve both employment and care quality in the sector.